Ship of Fools: Counselling abortion

Thread: Counselling abortion Board: Oblivion / Ship of Fools.

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Posted by Hawk (# 14289) on :

This proposal is currently being discussed in the UK. From what I understand it is a proposal by MP Nadine Dorries that the charities providing abortions should not be also counselling women and giving advice about abortions, since this was a conflict of interest.

The argument is, that if someone is paid to provide abortions, then their advice will be biased towards advising women to have abortions even when not entirely necessary. The counter argument is that this will cause delays for women seeking abortions. It also casts aspersions on the abortion service people that they are biased in their advice, when they may not be.

What do people think. Should the advice given be independently provided or is this an appalling idea? Personally I think in principle its usually a good idea to make counselling services for anything independent of one side or the other. But I'm not sure about this situation, since abortion is such a difficult subject at the best of times.

Posted by Matt Black (# 2210) on :

There does rather seem to be a conflict of interest there so I would be in favour of such a reform; it's a shame though that Mad Nad is proposing it as in consequence it will almost certainly fail.

Posted by Imaginary Friend (# 186) on :

quote:
Originally posted by Hawk:
Should the advice given be independently provided or is this an appalling idea?

I've been following this story from early on. In principle, I don't think I have a problem with counseling being provided by an independent organization. What I definitely do object to is that this amendment would make a complete free-for-all and allow many explicitly anti-abortion groups to provide this counseling. Fundy evangelicals with an official mouthpiece to tell lies about the issue is not what anyone needs! So I really hope that this amendment is voted down (it looks like it will be, given Number 10's intervention yesterday) because I think it will have horrible outcomes for the women involved.

I could go off on another rant about the way that the current government is doing policy and how its media machine is compulsively deceiving the public, but I'll save that for another day. [Biased]

Edited to add:
Matt Black, the current conflict of interest is much smaller than the potential outcomes of the amendment.

[ 01. September 2011, 11:56: Message edited by: Imaginary Friend ]

Posted by Curiosity killed ... (# 11770) on :

Currently, the counselling on offer is from clinics that offer abortions, and organisations that are anti-abortion. The misinformation from the anti-abortion groups is frightening. The risks from an abortion are made much of, but no comparison with risks of carrying a baby to term, for example.

Posted by ken (# 2460) on :

I think that if Nadine Dorries supports anything that's a pretty big clue that its probably a bad idea.

She has a well-documented history of lies and corruption, as well as supporting pretty much any oppressive right-wing joke policy that comes along. Its amazing that the Tories still put up with her.

Yes, this is the Nadine Dorries who lied on her blog claiming that she was doing political work in her constuency when she was off partying somwhere. Not once or twice but consistently for a couple of years. And who tried the same trick to claim expenses for a "second home" she hardly ever visited. And who consistently uses innuendo and lies to try to destroy the life of anyone who crosses her - including the ex-wives of more than one of the men she has had adulterous relationships with (and that was in the Daily Telegraph as well as the Daily Mail)

Yes, this is that Nadine Dorries. Shame on the Conservative Party for selecting such a woman as a candidate.

[ 01. September 2011, 12:51: Message edited by: ken ]

Posted by Crœsos (# 238) on :

quote:
Originally posted by Hawk:
The argument is, that if someone is paid to provide abortions, then their advice will be biased towards advising women to have abortions even when not entirely necessary. The counter argument is that this will cause delays for women seeking abortions. It also casts aspersions on the abortion service people that they are biased in their advice, when they may not be.

The argument is offered in bad faith, and obviously so. If it's a conflict of interest to get abortion counselling from the same organization you're getting your abortion from, it's just as much a conflict of interest to get advice from your doctor about an appendectomy or cancer treatment. This is just an attempt to make getting an abortion as bureaucratically complicated as possible in a manner no one would accept for any other medical procedure.

Posted by Matt Black (# 2210) on :

Except that an appendectomy doesn't have the moral maze attached to it that an abortion has.

Posted by Crœsos (# 238) on :

quote:
Originally posted by Matt Black:
Except that an appendectomy doesn't have the moral maze attached to it that an abortion has.

Try explaining that to a Christian Scientist or any other 'healing prayer only' cultist.

But that's largely irrelevant to the question at hand. The argument is cast in terms of financial conflict of interest, not "you've got the wrong morality".

Posted by Hawk (# 14289) on :

quote:
Originally posted by Crœsos:

quote:
Originally posted by Matt Black:
Except that an appendectomy doesn't have the moral maze attached to it that an abortion has.
Try explaining that to a Christian Scientist or any other 'healing prayer only' cultist.

But that's largely irrelevant to the question at hand. The argument is cast in terms of financial conflict of interest, not "you've got the wrong morality".

It depends on the flow of money I think. In an appendectomy consultation the (UK) doctor is paid his salary regardless of whether the patient gets an appendectomy or not. The question is whether the abortion provider is paid extra depending on how many abortions they carry out. I have no information either way but I suspect that is where the argument is coming from.

(In a US model your analogy is more correct though as I think US private doctors do get paid depending on how much expensive treatment they sell to the patient. This can be a problem with private healthcare.)

Posted by Matt Black (# 2210) on :

quote:
Originally posted by Crœsos:

quote:
Originally posted by Matt Black:
Except that an appendectomy doesn't have the moral maze attached to it that an abortion has.
Try explaining that to a Christian Scientist or any other 'healing prayer only' cultist.

But that's largely irrelevant to the question at hand. The argument is cast in terms of financial conflict of interest, not "you've got the wrong morality".

Since when was conflict of interest not a moral issue?

Posted by Crœsos (# 238) on :

quote:
Originally posted by Matt Black:

quote:
Originally posted by Crœsos:

quote:
Originally posted by Matt Black:
Except that an appendectomy doesn't have the moral maze attached to it that an abortion has.
Try explaining that to a Christian Scientist or any other 'healing prayer only' cultist.

But that's largely irrelevant to the question at hand. The argument is cast in terms of financial conflict of interest, not "you've got the wrong morality".
Since when was conflict of interest not a moral issue?

It can be, but financial conflict of interest for medical providers is not, as the proposed bill implies, exclusive to abortion.

Posted by Dafyd (# 5549) on :

quote:
Originally posted by Hawk:
From what I understand it is a proposal by MP Nadine Dorries that the charities providing abortions should not be also counselling women and giving advice about abortions, since this was a conflict of interest.

What exactly is supposed to be going on here? If it were a private medical provider operating on a profit basis, I can see that it can charge the woman more if she does an abortion. But we don't seem to be talking about private medical providers. We seem to be talking about charities. Are people supposed to be donating to these charities on a pay per abortion basis? That's not how I've ever given to any charity I've ever given to.
It looks like dodgy scaremongering to me.
Besides, the same reasoning should apply equally to charities that set out to support women who bear children to term.

Posted by no_prophet (# 15560) on :

Living in a country with no abortion law at all - which works fine, with a lower rate of abortion than our American friends to the south who have such laws - I am of the firm opinion that there should be no interference with health and social decisions related to abortion at all. None.

But there will always be those who understand that they cannot win the battle directly, so try to do it from a sideways approach. Reminds of the failed attempts to get creationism into schools, which failed, so they invented [un]intelligent design.

Posted by orfeo (# 13878) on :

quote:
Originally posted by Crœsos:

quote:
Originally posted by Matt Black:

quote:
Originally posted by Crœsos:

quote:
Originally posted by Matt Black:
Except that an appendectomy doesn't have the moral maze attached to it that an abortion has.
Try explaining that to a Christian Scientist or any other 'healing prayer only' cultist.

But that's largely irrelevant to the question at hand. The argument is cast in terms of financial conflict of interest, not "you've got the wrong morality".
Since when was conflict of interest not a moral issue?
It can be, but financial conflict of interest for medical providers is not, as the proposed bill implies, exclusive to abortion.

Yes, I think you've hit on the problem here. The conflict of interest argument sounds perfectly plausible, but it's being targeted at a particular area because of the morality angle of abortions, not because of the 'morality' of having a financial conflict of interest. If this kind of conflict of interest is considered unacceptable then consistent treatment would require a much larger range of services/products to be told that they, too, aren't allowed to advise their benefits.

Posted by Eliab (# 9153) on :

quote:
Originally posted by Crœsos:
The argument is offered in bad faith, and obviously so.

Agree absolutely.

I'm a lawyer. I advice people whether they should take their claims to trial. I also get paid to represent people at trials. No one, as far as I know, suggests that this situation is crying out for reform, or that my advice is inherently tainted by a conflict of interest.

In actual fact, of course, I often (indeed, usually) advise people not to go to trial, because it's not in their interests, and it hardly requires a heroic level of self-sacrifice for me to just do my job and tell them that. Unless this proposal is being extended to (or can be clearly distinguished in principle from) every other case where a professional is called upon to advise someone on whether to use a service which that person supplies - which of course it is not - the lack of integrity is palpable.

Posted by Arabella Purity Winterbottom (# 3434) on :

The abortion providers I know about prevent more abortions than any anti-abortionist. Dorries' argument is so simplistic it disgusts me.

Our local clinic does abortions after they have made absolutely sure that the woman actually wants and is prepared for the aftermath of an abortion. They push no one into having an abortion, and they will not go ahead in situations of doubt. They are paid by the government, not privately, and part of the role of the clinic is to help women and their partners come to a decision - which might be to go ahead and have the baby.

I'm guessing this is too much of a nuanced point of view for Ms Dorries and her ilk. Along with the idea that even I, like many committed pro-choicers, would prefer that abortions weren't necessary.

Posted by JoannaP (# 4493) on :

I found this article from The Guardian interesting.
It confirms Eliab's experience - unless one believes that a nurse who has chosen to work in this field is therefore evil and the standard generalisations about nurses wanting to help people no longer apply.

Posted by Hawk (# 14289) on :

quote:
Originally posted by Arabella Purity Winterbottom:
The abortion providers I know about prevent more abortions than any anti-abortionist.

It appears to me that often pro-abortionists and anti-abortionists are usually in agreement that abortion is not to be considered a good outcome, and ideally should be reduced as much as humanely possible. The means differ, and the attitude towards the women involved. But the ends, of reducing abortions, is the same. Is this right do you think?

If so, do you think that the current way of providing abortion services is correct in it's aim of attempting to reduce abortions while at the same time providing them as a final resort? I was struck by the Guardian article JoannaP linked to, where counselling is often given on the same day as the abortion is carried out. Surely, I would suggest, giving time, perhaps even a week or two between the counselling (where time allows of course and it's not an emergency) and the procedure, would be a better way, allowing the pregnant woman time to think about it and the various options available, rather than just getting it over with straight away. Abortion is of course an extremely important decision, and personally, even with minor decisions I find it best to at least sleep on my options before making a final decision.

This is perhaps just one measure that could be introduced to reduce the amount of abortions, and it wouldn't harm the women or prevent them from having the procedure if they did decide it was the best option. What do people think?

Posted by JoannaP (# 4493) on :

quote:
Originally posted by Hawk:

quote:
Originally posted by Arabella Purity Winterbottom:
The abortion providers I know about prevent more abortions than any anti-abortionist.
It appears to me that often pro-abortionists and anti-abortionists are usually in agreement that abortion is not to be considered a good outcome, and ideally should be reduced as much as humanely possible. The means differ, and the attitude towards the women involved. But the ends, of reducing abortions, is the same. Is this right do you think?

That is why "pro-choice" is considered to be a better term than "pro-abortionist". I certainly woud be surprised if you could find a pro-choice person who disagrees with Hilary Clinton's statement that "Abortion should be legal, safe and rare."

Re the time between counselling and the procedure, isn't the problem that the longer a woman waits, the more complicated (and riskier) the procedure is?

Posted by OliviaG (# 9881) on :

quote:
Originally posted by Hawk:
... Surely, I would suggest, giving time, perhaps even a week or two between the counselling (where time allows of course and it's not an emergency) and the procedure, would be a better way, allowing the pregnant woman time to think about it and the various options available, ...

What makes you think she hasn't? Honestly, I suspect she hasn't been able to think of anything else since she found out she's pregnant. OliviaG

Posted by Leaf (# 14169) on :

Much to my surprise, I can see Hawk's point. As a society we do make people wait before engaging even in an important personal decision. Case in point: marriage license. Where I live, a marriage license must be procured twenty-four hours before the solemnization of marriage. I suppose this is meant to prevent the possibility of rushing into a hasty decision. However, I suspect the number of people who get a marriage license and then desert at the altar is vanishingly small.

Twenty-four hours - certainly not weeks in the case of abortion because it's so time-sensitive (unless that was the point, to prevent abortion unto the point of viability) - does not seem unreasonable as a time of consideration.

OTOH there are jurisdictions where one is not required to wait twenty-four hours before the solemnization of marriage. The people purchasing a marriage license are adults of sound mind who intend to marry, and the state does not nanny them into any waiting period.

Posted by Justinian (# 5357) on :

quote:
Originally posted by Hawk:
It appears to me that often pro-abortionists and anti-abortionists are usually in agreement that abortion is not to be considered a good outcome, and ideally should be reduced as much as humanely possible. The means differ, and the attitude towards the women involved. But the ends, of reducing abortions, is the same. Is this right do you think?

From observational evidence I strongly disagree. The pro-Choice lobby is in favour of reducing the abortion rate and wants to make abortion safe, legal, and rare.

If the so-called pro-Life lobby actually cared about the abortion rate rather than pointing the finger and feeling smugly self-righteous when things went wrong, their behaviour would be very different. Notably they would be entirely against abstinance only sex education, and almost entirely in favour of Emergency Hormonal Contraception (a.k.a. the "morning after pill"). The means do not differ so much as the goal. The so-called pro-Life lobby merely wants to go back to the days of wire coathangers. Otherwise they'd be doing things that actually reduced the need for abortions rather than increasing it.

quote:
If so, do you think that the current way of providing abortion services is correct in it's aim of attempting to reduce abortions while at the same time providing them as a final resort?

I do.

quote:
I was struck by the Guardian article JoannaP linked to, where counselling is often given on the same day as the abortion is carried out.

Get it done fast. That baby grows. And the longer you wait the worse things get. Besides. If the mother actually wants to wait another week to think things through, she can. Her choice. And she won't be fined for it (or have to pay at all) in Britain. She's already had time to think about it and almost certainly been thinking about little else as OliviaG says.

Posted by Justinian (# 5357) on :

And just to kick Hawk's point further into the long grass:

quote:
From the Guardian article:
Over the last year 17.3% of women seen by BPAS had consultation and treatment on the same day, and in recent months they have made more same-day appointments available because of demand.

Patients who want an abortion want to have the counselling and the abortion on the same day. This is their choice. Why do you want to force them to wait? They've already had weeks and just want to get matters over with. Medically the right thing to do if you're going to have an abortion at all is to get it over with. Psychologically they want to brace themselves as few times as possible. And they've already had some time to adapt.

Who are you, Hawk, to disagree with the patients, the doctors, and the counsillors about what is best?

Posted by OliviaG (# 9881) on :

quote:
Originally posted by Justinian:
... If the so-called pro-Life lobby actually cared about the abortion rate rather than pointing the finger and feeling smugly self-righteous when things went wrong, their behaviour would be very different. ... they'd be doing things that actually reduced the need for abortions rather than increasing it. ...

For starters, they would be handing out condoms at their events. Everyone else does. [Biased]

OliviaG

Posted by Crœsos (# 238) on :

In the U.S. waiting periods are part of a deliberate strategy by abortion opponents to make getting an abortion so complicated it becomes unavailable as a practical matter even if it's still legal. Given the long distances most women living in the rural areas have to travel to obtain an abortion, most waiting periods laws are designed to have no other effect than to turn a day trip into an overnight trip, with all the attendant increase in logistical complexity.

Of course, such laws fit very nicely with the "stupid women need us to make their decisions for them" mentality often found among opponents of abortion.

Posted by Hawk (# 14289) on :

quote:
Originally posted by Justinian:
Patients who want an abortion want to have the counselling and the abortion on the same day. This is their choice. Why do you want to force them to wait? They've already had weeks and just want to get matters over with

Why do you want to force them to have counselling at all? If they're healthy and unwantedly pregnant why not just do it with no questions asked? It's to give them the available options, educate them about the possibilities and assist them to make the best decision for themselves based on their particular circumstances. I think giving time to think things through after being presented with the information might be a good part of this. Is that such a shocking thing to say?

It's a stressful situation I imagine, and many women probably do want to just get it over and done with and not have to think any more about it. But in some situations that might not be the best option for them. I know that's heresy for pro-choicers who consider personal choice to be some kind of inviolate totem, but that ignores the fact that sometimes people do make poor decisions that they later regret. Of course a person's decision is their decision, and final, but it is beneficial to them, I would suggest, that a certain amount of enforced 'time out' is built into the counselling process before making the final decision. Otherwsie a person may make a decision in the heat and stress of the moment that they later regret.

quote:
Originally posted by OliviaG:
What makes you think she hasn't? Honestly, I suspect she hasn't been able to think of anything else since she found out she's pregnant. OliviaG

Some of them are well informed of course, and have many knowedgeable and caring friends and family members to discuss their options with, and have already made their decision before reaching the consultation room. Some people may turn up so ignorant they don't even know exactly what an abortion is. For some people some time to digest the information they are suddenly presented with for the first time, and to read the information they are given, is necessary.

quote:
Originally posted by JoannaP:
Re the time between counselling and the procedure, isn't the problem that the longer a woman waits, the more complicated (and riskier) the procedure is?

With late abortions yes, and in those situations where time is of the essence then fair enough. But I'm talking about the situations when an extra day or a week will make no difference to the type or risk of the procedure being carried out.

quote:
Originally posted by Crœsos:
In the U.S. waiting periods are part of a deliberate strategy by abortion opponents to make getting an abortion so complicated it becomes unavailable as a practical matter even if it's still legal. Given the long distances most women living in the rural areas have to travel to obtain an abortion, most waiting periods laws are designed to have no other effect than to turn a day trip into an overnight trip, with all the attendant increase in logistical complexity.

Of course, such laws fit very nicely with the "stupid women need us to make their decisions for them" mentality often found among opponents of abortion.

Of course, and that is a terrible stalking horse policy. But that doesn't mean a small waiting period is of itself a bad thing, just that it can be misused.

quote:
Originally posted by Justinian:
Who are you, Hawk, to disagree with the patients, the doctors, and the counsillors about what is best?

Nobody at all. That's why I'm just pondering this on an online forum rather than taking to the streets. If such an idea was ever to be made common policy it should of course be done by the agreement and implementation of the medical and counselling professionals involved.

Posted by OliviaG (# 9881) on :

quote:
Originally posted by Hawk:
Why do you want to force them to have counselling at all? If they're healthy and unwantedly pregnant why not just do it with no questions asked? It's to give them the available options, educate them about the possibilities and assist them to make the best decision for themselves based on their particular circumstances. ...

A certain amount of information comes with any medical procedure, such as a description of the procedure, recovery process, potential complications and side effects, other medical options, etc. Even in the absence of formal "counselling," a patient will get this information prior to an abortion. OliviaG

Posted by cheesymarzipan (# 9442) on :

According to this page, Nadine Dorries has already been slagging off BPAS by saying they don't provide enough counselling sessions (even though they say that they do)

Posted by Penny S (# 14768) on :

Last time I heard her, she was saying that she wanted women to be offered counselling if they wanted it, and it should be from independent counsellors, who shouldn't be associated with BPAS, the Royal College of Gynaecologists, or Marie Stopes, or, and this was surprising, any religious group. The counselling wasn't to be compulsory.

This was different from previous things she said.

I remain puzzled that the group Right to Know, which supports her, does not think anyone has the right to know who is funding them, or who they are linked with.

I was at college with someone who nearly died fom a self-administered knitting needle, back before there was any legal provision, and really don't want us to go back there. Which is where we would arrive if access were limited.

Penny

Posted by leo (# 1458) on :

I used to belong to the Society for the Protection of the Unborn Child and Life. (I was a Tory too- thankfully, I grew up.)

They claim to 'counsel' but all the evidence I have seen suggests that they are less impartial that BPAS and Stopes.

I am glad the debate in parliament was lost.

Nobody thinks that abortion is 'a good thing' but pregnant girls often have nobody to turn to and it is pastorally essential that they have access to counselling that is unbiased and which helps them make their own decisions.

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